12 Causes of Premature Ejaculation: Insights from an Expert

Premature ejaculation manifests when a man attains climax sooner than intended during intimate encounters, impacting both his satisfaction and that of his partner. This prevalent concern affects 30% to 40% of men and stems from a confluence of physical, chemical, and emotional/psychological factors. Delve into the following article for a comprehensive exploration of the underlying causes of premature ejaculation.

12 Causes of Premature Ejaculation

Premature ejaculation was traditionally considered a psychological issue. However, modern research suggests that some men, particularly those with lifelong premature ejaculation, may experience neurobiological factors – specifically, a chemical imbalance in the brain that controls ejaculation. This imbalance can lead to increased sensitivity, reduced control, and performance anxiety, creating a cycle of both psychological and physiological issues.

Here are 12 common causes of premature ejaculation, divided into neurobiological, psychological, and lifestyle/medical factors:

Neurobiological Factors

1. Chemical imbalance in the brain
An imbalance of neurotransmitters such as serotonin and dopamine can cause the ejaculatory control centre in the brain to become overactive, leading to premature ejaculation.

2. Hypersensitivity of the penis
Some men have a naturally higher penile sensitivity due to nerve-related factors or genetics, making it more difficult to delay ejaculation.

3. Genetic factors
Research suggests that lifelong premature ejaculation may have a hereditary component, affecting the body’s ability to regulate ejaculation.

Psychological Factors

4. Performance anxiety
Men who fear not satisfying their partner may become overly anxious, leading to involuntary early ejaculation.

5. Depression and anxiety disorders
Those suffering from chronic depression or anxiety often have low serotonin levels, which can impact ejaculatory control.

6. Fear of failure or rejection
Worrying about not meeting a partner’s expectations can create stress, increasing the likelihood of premature ejaculation.

7. Past trauma or negative sexual experiences
Men who have experienced rushed, stressful, or traumatic sexual encounters in the past may develop a pattern of rapid ejaculation.

Lifestyle and Medical Factors

8. Excessive or improper masturbation
Frequent fast or intense masturbation, particularly in stressful situations, can condition the body to ejaculate quickly during sex.

9. Chronic health conditions
Medical conditions such as diabetes, high blood pressure, obesity, and hormonal imbalances can interfere with nerve function and ejaculatory reflexes.

10. Genital infections or inflammation
Conditions like prostatitis (prostate inflammation), urethritis (urinary tract inflammation), or balanitis (foreskin inflammation) can increase penile sensitivity, making ejaculation harder to control.

11. Substance use (alcohol, tobacco, drugs)
Alcohol, nicotine, and recreational drugs can disrupt dopamine and serotonin levels, leading to poor ejaculatory control.

12. Link to erectile dysfunction (ED)
Men with erectile dysfunction often develop premature ejaculation due to anxiety about losing their erection, which causes them to rush sexual activity.

Identifying the underlying cause of premature ejaculation is essential for finding the right treatment, whether through lifestyle changes, therapy, or medical intervention.

Premature Ejaculation Treatment

Initiating the journey towards premature ejaculation treatment through consultation with a physician or a certified sex therapist is a prudent decision. The chosen treatment approach hinges on the root causes of the condition and whether it is a persistent or acquired issue. Treatment options encompass:

1. Psychological and Behavioral Therapy

Behavioral therapy involves the exploration of various techniques aimed at delaying climax. The objective is to impart control over both physiological and emotional responses. Techniques include:

• Start-Stop Technique: Collaboratively with your partner, stimulate your penis close to climax and then interrupt stimulation for approximately 30 seconds until mastery over your response is regained. Reiterate the “start and stop” process three or four times before allowing climax. Persistence in this technique enhances control.
• Squeeze Technique: This method involves stimulating the penis near climax and gently squeezing the glans for about 30 seconds to induce loss of erection. Replicate this technique several times before permitting climax. Consistent practice contributes to gaining mastery over delaying climax.
• Distracting Thoughts: Redirecting focus towards unrelated, mundane thoughts during sexual stimulation is part of this technique. Structuring a mental list serves as an effective distraction. For example, mentally list the businesses passed on the way to the gym, the players in a favorite sports team, or the products on the shelves of a preferred store.

2. Psychological Counseling

When the crux of premature ejaculation lies in psychological, emotional, or relational complexities such as performance anxiety, depression, stress, guilt, or relationship discord, seeking guidance from psychologists, psychotherapists, couples’ therapists, or sex therapists is advised. Your urologist can facilitate referrals to these healthcare professionals. Under the expert guidance of a seasoned sex therapist, underlying sexual concerns can be explored and alleviated.

3. Reducing Penis Sensation

Topical anesthetics, comprising sprays and creams, are employed to mitigate penile sensitivity and are applied 30 minutes before intercourse. Utilizing these treatments in conjunction with condoms prevents absorption by the partner. The use of two condoms can further diminish sensitivity.

4. Medication

If premature ejaculation is intertwined with erectile dysfunction, medications addressing erectile dysfunction, such as PDE5 inhibitors (Viagra, Cialis, Levitra), may aid in regaining control over ejaculation.

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like citalopram, escitalopram, fluoxetine, paroxetine, and sertraline, or tricyclic antidepressants like clomipramine, exhibit efficacy in delaying premature ejaculation. This application is considered off-label (not FDA-approved for this purpose). A thorough discussion regarding potential side effects should be conducted with your urologist to ensure appropriateness.

SSRIs and tricyclic antidepressants, recognized for their delay in ejaculation when used for treating depression, can be beneficial for premature ejaculation when employed alongside counseling. SSRIs may present side effects such as reduced libido, nausea, sweating, gastrointestinal disturbances, and fatigue. Dapoxetine, a specific SSRI, stands as the lone FDA-approved medication for treating premature ejaculation and is taken on-demand before sexual activity.

Topical anesthetics, in the form of creams and sprays applied to the head and shaft of the penis, represent an additional medication option for delaying ejaculation. Application should occur 10 to 30 minutes prior to intercourse or until diminished sensitivity is perceived. It is imperative to cleanse the penis before sexual activity to prevent numbing the partner’s vagina or compromising the ability to sustain an erection.

Premature ejaculation, often amenable to treatment through straightforward measures, underscores the importance of consulting a urologist or relevant healthcare professionals when experiencing such concerns.